The Third Plenary Session of the Eleventh Central Committee of the Communist Party of China established the main theme of reform and opening up. In the process of transforming from a planned economy to a market economy, the institutional background of China's medical security began to undergo major changes, and the traditional medical security system gradually lost its existence.
Base.
The reform of the urban basic medical security system is closely related to the reform of the fiscal system, the reform of the medical system, the establishment of the modern enterprise system and changes in the ownership structure.
With the progress of reform and opening up in various related fields, the reform of the medical security system is a matter of course.
Publicly funded and labor insurance medical systems mainly appeared before the reform and opening up, so I won’t go into too much detail here.
Medical security reform pilot.
Since the early 1980s, some enterprises and localities have begun to spontaneously explore the reform of the traditional employee medical security system, such as a fixed quota for medical expenses or only reimbursement of over-expenditures at a certain percentage, and the implementation of medical expense payment and individual
The continuous development of these reform practices, such as interest-linked methods, has also laid a certain psychological foundation for individual employees to bear medical expenses, showing a transition from a publicly funded medical system to a moderate self-pay system.
In order to further solve the increasingly prominent problems in the field of medical security, on April 28, 1984, the Ministry of Health and the Ministry of Finance jointly issued the "Notice on Further Strengthening the Management of Publicly Funded Medical Care", proposing to actively and prudently reform the public medical care system, and began the government's reform of the public medical care system.
A new stage of exploration in the reform of the traditional publicly funded medical system.
Local governments were the first to intervene in the practice of medical system reform. The main method is to control costs through social co-ordination. For example, since November 1985, Shijiazhuang, Hebei Province has launched a social network on retiree medical expenses in six counties and cities.
Coordination pilot; In May 1987, Beijing Dongcheng District Vegetable Company pioneered the "major disease medical co-ordination", which provided a relatively easy-to-operate solution to the thorny problem of huge medical expenses.
On March 25, 1988, with the approval of the State Council, a medical system reform plan was established, led by the Ministry of Health and participated by eight departments including the National Restructuring Commission, the Ministry of Labor, the Ministry of Health, the Ministry of Finance, and the State Administration of Medicine, to study and implement the medical reform.
Pilot guidance.
In July of the same year, the group launched the "Imagination on the Employee Medical Insurance System (Draft)".
In 1989, the Ministry of Health and the Ministry of Finance promulgated the "Notice on the Management Measures for Publicly Funded Medical Care", which explained 13 specific self-pay items within the scope of public medical expenses.
In March of the same year, the State Council approved the "Key Points of the Economic System Reform of the National Restructuring Commission in 1989", pointing out that pilot projects for the reform of the medical insurance system should be carried out in Dandong, Siping, Huangshi and Zhuzhou, and pilot projects for the comprehensive reform of the social security system should be carried out in Shenzhen and Hainan.
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Under the guidance of relevant policies, Siping City in Jilin Province took the lead in conducting a medical insurance pilot, and Bishan County in Chongqing City also made some attempts at reform based on the pilot plan.
In April 1990, Siping City's public health care reform plan was released; in November 1991, Hainan Province promulgated the "Hainan Province Employee Medical Insurance Interim Regulations" and came into effect in 1992; in September 1991, Shenzhen City established the Medical Insurance Bureau
, and in May 1992, the "Interim Provisions on Shenzhen Employees' Medical Insurance" and the "Details for the Implementation of Employees' Medical Insurance" were promulgated.
In 1994, the National Restructuring Commission, the Ministry of Finance, the Ministry of Labor, and the Ministry of Health jointly formulated the "Pilot Opinions on the Reform of the Employee Medical System". With the approval of the State Council, pilot projects were carried out in Zhenjiang City, Jiangsu Province, and Jiujiang City, Jiangxi Province.
, the famous “Two Rivers Pilot Project”.
The new rural medical reform is based on the "Liangjiang Pilot". In April 1996, the General Office of the State Council forwarded the "Opinions on the Pilot Expansion of the Reform and Expansion of the Employee Medical Security System" from the National Restructuring Commission, the Ministry of Finance, the Ministry of Labor, and the Ministry of Health.
, conduct a larger-scale pilot.
According to the unified deployment, 58 cities were selected nationwide for the medical security pilot work in 1997. By the beginning of August, more than 30 cities had launched medical reform expansion pilots.
By the end of 1998, 4.017 million employees and 1.076 million retirees had participated in the reform of combining social pooling of medical insurance with personal accounts nationwide. The medical insurance fund income for that year reached 1.95 billion yuan.
By 1999, all 58 cities identified as pilot areas had carried out pilot work.
The "Liangjiang Pilot" has initially established a medical insurance model for urban employees that combines medical insurance with a unified account (a combination of social pooling and personal accounts).
This model has received good response from the society after expanding the pilot program.
At the same time, many cities across the country have carried out some reform and exploration of payment mechanisms in accordance with the principle of "integration of accounts and accounts".
In addition to the "three-channel" unified accounting model of the "Liangjiang Pilot", the specific models of integrated accounting mainly include: Shenzhen hybrid model, which implements different levels of insurance models for different types of people, mainly including comprehensive medical care
There are three levels of insurance, hospitalization medical insurance, and special medical insurance; Hainan's "dual-track parallel" model adopts the method of separate management of personal accounts and social pooling funds. The latter is used to pay for hospitalization expenses and cannot be overdrawn from the former. It is managed by the Social Security Bureau
and operation; the basic approach of Qingdao's "three golds" model is to add a unit adjustment fund between the establishment of personal account funds and overall medical care funds, which shall be paid jointly by the enterprise and individual employees. The unit adjustment funds and personal account funds shall be paid by
Business Management.
The establishment of urban basic medical insurance system.